Children with issues in classroom may have sleep disorder

Children who show ADD or ADHD symptoms in the classroom may be experiencing a sleep disorder.

More parents are waking up to the fact that sleep disorders are more common than most of us think. Now the American Academy of Pediatrics and doctors continue to warn parents that sleep disorders can trick you into thinking you’re dealing with something else all together.

Dr. Akinyemi Ajayi, the Medical Director of Children’s Sleep Lab, says that when a child is tired and can’t focus in the classroom or they’re fidgeting to stay awake, a teacher sees that and may presume the child has ADD and ADHD.

Parents Garrett and Joey Myers had the same problem with their twin daughters Monica and Megan. The girls were never diagnosed with a learning disorder, and it was a journey of many doctor visits to figure out why there girls where having behavioral problems.

“It’s a never ending battle of what looks like eating disorder or anxiety or OCD,” said Garret Myers, the girls’ father.

As the parents visited one medical expert after the next, mom Joey Myers, tried to ask doctors if the twins could possibly have narcolepsy, like she was diagnosed with in adulthood. So finally, the Myers met Dr. Ajayi, who after a series of test, determined the twins did have narcolepsy.

The girls are now being treated at separate therapeutic boarding schools out of state. “They basically have to finish growing up,” said Garrett Myers. “They stopped and at 10-years old, they regressed.”

Now the parents are trying to educate others moms and dad to be vigilant if they feel their child might be experiencing problems because of a sleep disorder.

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The link between sleep and children's mental health is...complicated...

A study indicates that a link exists between children with sleep disorders and their mental health.

Toddlers who take a long time to fall asleep or wake up many times during the night have put many a desperate mom and dad to the test. Tired parents are often told that night waking is part of toddlerhood, and that it will soon pass on its own, but this is not the case for everyone.

Researchers at NTNU's Department of Psychology have conducted a comprehensive survey of nearly 1,000 toddlers that shows that serious sleep disorders in young children can have long-term consequences.

The study shows that four-year-olds with sleep disorders have a higher risk of developing symptoms of psychiatric problems as six-year-olds, compared with children who sleep soundly.

At the same time, four-year-olds with psychiatric symptoms have a greater risk of developing a sleep disorder as six-year-olds, compared with children who do not have these kind of symptoms.

Reciprocal relationship

"It is common for children to have periods when they sleep poorly, but for some children, the problems are so extensive that they constitute a sleep disorder. Our research shows that it is important to identify children with sleep disorders, so that remedial measures can be taken. Sleeping badly or too little affects a child's day-to-day functioning, but we are seeing that there are also long term repercussions," says Silje Steinsbekk, an Associate Professor and Psychologist in NTNU's Department of Psychology.

Her previous research on the relationship between sleep disorders and psychological problems in children has shown that four-year-olds with sleep disorders often also show symptoms of psychiatric problems.

The new study, which was recently published in the Journal of Developmental & Behavioral Pediatrics, shows that the correlation between sleep disorders and psychiatric disorders is also found over time and that the relationship is reciprocal.

Thorough interviews and diagnoses

We know that 20-40 per cent of young children struggle with sleep in one way or another, but we lack data on how many of them are suffering from a diagnosable sleep disorder.

NTNU researchers conducted diagnostic interviews with the parents of the children participating in the study. The interview was based on the DSM-IV diagnostic manual, which contains the official diagnostic criteria for mental disorders.

One thousand four-year-olds participated in the study. Parents of around 800 of these children were interviewed again two years later. The comprehensive study is part of a longitudinal study in Trondheim that examines the incidence, progression and risk factors for the development of mental health problems in children. The project conducts follow-up visits with the children and their parents every other year.

"Previous studies of sleep problems in children have mainly used a questionnaire format, with questions like, "Does your child have trouble sleeping?" But what parents define as sleep problems will vary. In the diagnostic interview we ask parents questions until we are confident that we have enough information to assess whether a symptom is present or not. The information we've collected is more reliable than information obtained from the questionnaire," says Steinsbekk.

What comes first?

Can we say that poor sleep causes psychiatric problems -- or do psychiatric problems cause poor sleep? The findings from the study suggest that the relationship goes both ways.

One possible explanation for this reciprocity may be that both conditions are biologically determined, by common underlying genetics, for example.

Another explanation may be that insufficient sleep creates general functional impairment, and that the risk of other problems therefore increases -- in the same way that psychiatric symptoms often result in poorer everyday functioning, which in turn may negatively affect sleep.

Vicious cycle

Perhaps sleep disorders and mental health issues share the same risk factors. A child who shows signs of anxiety or a behavioural disorder may easily end up in a vicious cycle, where conflict with adults triggers anxiety and in turn leads to trouble falling asleep.

It may also be that difficult and negative thoughts steal both energy and sleep and make us restless and depressed if we fail to gain control over them.

"Given that so many children suffer from insomnia, and only just over half 'outgrow it,' it is critical for us to be able to provide thorough identification and good treatment. Perhaps early treatment of mental health problems can also prevent the development of sleep disorders, since psychiatric symptoms increase the risk of developing insomnia," says Steinsbekk, stressing that this is something that must be examined in further research.

Insomnia is most prevalent The study shows that insomnia is the most prevalent sleep disorder. Children who suffer from insomnia struggle with falling asleep and frequent waking. Insomnia was diagnosed in 16.6 per cent of the four-year-olds surveyed, and 43 per cent of these still had insomnia as six- year olds.

Insomnia in four-year olds increases the risk for symptoms of anxiety, depression, ADHD and behavioural problems as six-year-olds. After the researchers had taken into account the children's psychiatric symptoms at age four, the relationship between insomnia and ADHD disappeared.

Similarly, children who show symptoms of anxiety, depression, ADHD and behavioural disturbances as four-year-olds have a greater risk of developing insomnia as six-year-olds. When symptoms of insomnia at age four were adjusted for, the relationship between insomnia and anxiety disappeared.

Examples of other types of sleep disorders are hypersomnia, i.e. an extreme urge to sleep, and various cases of parasomnia, such as nightmares, night terrors and sleepwalking. These conditions are uncommon, and the study also shows that, with the exception of sleepwalking, they are shorter-lived.

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Childhood sleep disorders could hurt a child's heath

When you think of sleep disorders in children, the first types likely to spring to mind are night terrors, nightmares and sleepwalking. These fall into a class of sleep disorders known as parasomnias.

It is estimated that up to 6.5% of children - particularly those aged 4-12 years - experience night terrors, defined as episodes of intense fear, screaming and flailing during sleep. Approximately 3% of preschool and school-aged children experience nightmares, while up to 15% of children aged 4-12 years sleepwalk.

Perhaps less associated with children and adolescents is insomnia and obstructive sleep apnea. In fact, insomnia, the inability to fall asleep or frequent awakening, is estimated to affect around 25% of children and teenagers. Obstructive sleep apnea - when an individual stops breathing for long periods during sleep - affects around 2-4% of children.

What are the causes and symptoms of childhood sleep disorders?

There are a number of factors that can cause childhood and adolescent sleep disorders.

Just like adults, children and teenagers can experience stress, which can interfere with sleep. Consumption of energy drinks - which contain caffeine - is also known to disrupt sleep, as is use of certain medications, such as antidepressants and corticosteroids.

Children and adolescents are also more likely to develop sleep disorders if they have a family history of such conditions, and poor sleep habits, or poor "sleep hygiene" - such as going to bed at irregular times or attempting to sleep in an inadequate environment - can negatively affect sleep quality.

Increasingly, researchers are pointing to the use of technology as a driver for sleep disorders. Last month,Medical News Today reported on a study published in BMJ Open that found children are 50% more likely to have problems getting to sleep if they spend 4 hours a day or more using media devices.

"In adolescents, with the increase in popularity of technology, many teens are staying up very late communicating with friends on smartphones and tablets. The stimulation and light exposure from these devices are associated with late bedtimes and insomnia," Dr. Neil Kline, a sleep physician and internist at the American Sleep Association, told MNT.

Although often harmless, snoring can be a major indicator for a sleep disorder in children and adolescents. It can be a sign of sleep apnea or disturbed sleep quality.

Other symptoms of sleep disorders to look out for include difficulty getting to sleep, daytime fatigue, poor memory, lack of concentration, reduced attention span, irritability and mood swings, hyperactivity and depression.

"If there is any concern for a sleep problem, such as a child taking longer than 20-30 minutes to fall asleep, not sleeping through the night after about age 1 year, or snoring, it is important to discuss this with the child's pediatrician, health care provider or a sleep doctor," Dr. Shalini Paruthi, a spokesperson for the American Academy of Sleep Medicine (AASM), told us.

Children and teenagers are not getting enough sleep

According to recently updated recommendations from the National Sleep Foundation (NSF), the number of hours sleep children and adolescents need is as follows:

Over the past 20 years, the number of hours teenagers sleep each night has fallen.

• Newborns (0-3 months): 14-17 hours a day
• Infants (4-11 months): 12-15 hours
• Toddlers (1-2 years): 11-14 hours
• Preschoolers (3-5 years): 10-13 hours
• School-age (6-13 years): 9-11 hours
• Teenagers (14-17 years): 8-10 hours.

However, it seems many children and teenagers are failing to meet sleep recommendations.

A 2014 poll from the NSF, which asked parents to estimate how much sleep their child gets on a school night, found that children aged 6-10 are only getting around 8.9 hours sleep a night, while 13-14-year-olds are only getting around 7.7 hours sleep each night.

More recently, MNT reported on a study published in the journal Pediatrics revealing that the number of hours teenagers sleep each night has declined over the past 20 years.

The study, which involved more than 270,000 adolescents, found that 72% of 15-year-olds were getting at least 7 hours or sleep each night in 1991, but this fell to only 63% in 2012.

"Declines in self-reported adolescent sleep across the last 20 years are concerning and suggest that there is potentially a significant public health concern that warrants health education and literacy approaches," said lead study author Dr. Katherine W. Keyes, of Columbia University's Mailman School of Public Health.

But why is lack of sleep among children and adolescents a public health concern?

Sleep deprivation linked to obesity, diabetes and heart problems

Sleep deprivation can cause a number of health problems for children and adolescents, both in childhood and adulthood.

In 2011, a study published in The BMJ claimed that children who do not get enough sleep are at significantly higher risk of becoming overweight, compared with children who get sufficient sleep.

Another study published in The Journal of Pediatrics in December 2014 reported a similar finding, associating severe lack of sleep and sleep-disordered breathing in early childhood with increased risk of obesity.

The researchers found that children with the shortest sleep time at the ages of 5 and 6 years were at 60-100% increased risk of obesity by the age of 15, compared with children with sufficient sleep times.

"If impaired sleep in childhood is conclusively shown to cause future obesity, it may be vital for parents and physicians to identify sleep problems early, so that corrective action can be taken and obesity prevented," commented lead study author Prof. Karen Bonuck, from the Albert Einstein College of Medicine of Yeshiva University in New York, NY.

In March last year, another study published in the same journal found that overweight adolescents who do not get enough sleep may be at increased risk of diabetes, heart disease and stroke.

Past studies have also associated sleep apnea in children with delayed growth and heart failure.

Lack of sleep 'makes it nearly impossible for children to reach their full potential'

It is widely accepted that sleep is important for learning and memory. In June 2014, MNT reported on a study that suggested as such. It found that sleep after learning boosts growth of connections between brain cells, helping them to communicate with each other.

A more recent study found that sleep is particularly important for infants' learning skills. Published in theProceedings of the National Academy of Sciences, the researchers revealed that infants aged 6-12 months who had at least one 30 minute nap within 4 hours of learning a new skill were much more likely to demonstrate the skills they learned once they awoke.

With findings such as these, it is no wonder that lack of sleep and poor sleep quality has been associated with poor learning and educational attainment among children and adolescents.

A 2013 study conducted by researchers from Boston College in the UK found that sleep deprivation was a major contributor to poor grades in numerous countries. While taking literacy tests, 76% of American 9-10-years-olds were identified as sleep-deprived, and these students were found to have poorer results.

"I think we underestimate the impact of sleep. Our data show that across countries internationally, on average, children who have more sleep achieve higher in maths, science and reading. That is exactly what our data show," study co-author Chad Minnich told BBC News.

Dr. Paruthi believes sufficient sleep is crucial for a child's overall health and development. She told MNT:

"Sleep disorders in children and teens can hinder them in school, in social situations, in development and nearly every other aspect of their lives, with the negative impact potentially extending into adulthood. Without healthy sleep, it will be nearly impossible for children to reach their full potential."

Parents should not assume children will 'grow out' of sleep disorders

It is possible that as a child or teenager gets older, symptoms of their sleep disorder may ease. This is most likely for parasomnias, such as sleepwalking and night terrors.

But in some cases, sleep disorders can persist well into adulthood. "For example, children who have sleep apnea are more likely to develop sleep apnea as adults," noted Dr. Kline.

As such, sleep physicians say parents should not ignore signs of sleep disorders in children with the assumption they will "grow out" of them.

"Parents should never assume that their child will grow out of a sleep disorder," Dr. Paruthi told us. "Parents should talk to their child's doctor about how their child sleeps and discuss any potential sleep problems. It is important for a doctor to monitor sleep problems during childhood, identify any underlying causes and prescribe appropriate treatment when necessary."

Depending on what form of sleep disorder a child has, there are a number of treatments available. Doctors may recommend a melatonin supplement, for example. Melatonin is a natural hormone made by the body that helps regulate sleep.

Cognitive behavioral therapy may also be useful, in which psychological approaches - rather than medication - are used to improve a child's sleep time and quality.

Tips to improve a child's sleep

But while there are a number of therapies that can help treat symptoms of sleep disorders, there are many things the NSF say parents can do to improve the likelihood of their child getting a good night's sleep:

The NSF say parents should ensure their child is sleeping in an adequate environment; if it is too noisy, too cold or too hot, this can disrupt sleep.

• Make sleep a primary health priority in your family
• Talk to your child about the importance of sleep for their health and well-being
• Set regular bedtimes for yourself and your children and stick to them
• Be aware of how your child is using media devices in the bedroom and set boundaries for use before bedtime
• Ensure you and your child are educated on how light from media devices may impair sleep
• Rather than watching TV, playing video games or browsing the Internet before bedtime, encourage your child to read a book or listen to music
• Ensure your child is sleeping in an adequate environment; if it is too noisy, too cold or too hot, this can disrupt sleep
• Talk to your child's teacher to find out about their alertness during the school day, and ask them to inform you if they fall asleep in lessons.

To find out more about how to improve your child's sleep, visit the NSF website. Our Knowledge Center articles provide more general information on specific sleep disorders, including obstructive sleep apneaand insomnia.

Sleep issues in children with mental health diagnoses

Sleep issues are common among children with mental health diagnoses, and may go undiagnosed due to the co-existing conditions.

Sleep difficulties, particularly problems falling asleep, are common among toddlers and preschoolers with mental health issues, according to a new study.

"Sleep problems in young children frequently co-occur with other behavioral problems, with evidence that inadequate sleep is associated with daytime sleepiness, less optimal preschool adjustment, and problems of irritability, hyperactivity and attention," said the study's leader, John Boekamp, clinical director of the pediatric partial hospital program at Bradley Hospital in Providence, R.I.

However, he said, sleep disorders may be unrecognized and underdiagnosed in young children, particularly when behavioral or emotional problems are present.

The study, published online in Child Psychiatry & Human Development, involved 183 children aged 6 years or younger receiving outpatient treatment for psychiatric problems. The researchers examined the prevalence of sleep disorders among these children and the nature of the sleep problems.

"The most common sleep difficulties reported nationally for toddlers and preschoolers are problems of going to bed, falling asleep and frequent night awakenings. Collectively, these problems are referred to as behavioral insomnias of childhood," said Boekamp in a hospital news release.

Recognized sleep disorders, particularly sleep onset insomnia, were more common than expected, the researchers found. Overall, 41 percent of children in the study met the criteria to diagnose a sleep disorder.

Sleep problems were most common in kids with disruptive behavior, and attention, anxiety and mood problems, the researchers found.

Early sleep problems could not only be the result of behavioral and emotional problems, but could also contribute to them, the researchers noted.

"Essentially, these young children might be caught in a cycle, with sleep disruption affecting their psychiatric symptoms, and psychiatric symptoms affecting their sleep-wake organization," said Boekamp. "It is important for families to be aware of how important sleep is to the behavioral adjustment and well-being of young children."

Sleep problems can complicate treatment for challenging behaviors, such as aggression and attention and mood problems. Daytime sleepiness and fatigue can make these problems even worse, the study's authors noted.

"This study is a great reminder that it's critical for mental health providers working with young children and their families to ask about children's sleep," said Boekamp.

"Simple questions about children's sleep patterns, including how long it takes a child to fall asleep at night and how frequently a child awakens after falling asleep, may yield important information that is relevant to clinical care, even when sleep problems are not the primary focus of treatment," he explained.

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Risks of sleep apnea - stroke, heart attack, pneumonia, dementia.

This article discusses the risks associated with untreated sleep apnea. My only comment for this article  is that "Sleep hygiene" does NOT treat sleep apnea. - JR

Sleep Apnea: The Real Risks Involved

Subscribe FreeBy Mike Tuttle · March 27, 2014 

"18 million Americans suffer from it. It can lead to both physical and psychological problems. Perhaps you, as many do, have it and aren’t even aware of it.

Sleep apnea is a sleep disorder that is characterized by snoring and pauses in breathing at night, waking the person momentarily before they fall back asleep. This disruption of sleep can occur several times a night, 5 to 30 times or more in just one hour. A person, both adults and children alike, can suffer from this disorder for years, even decades, before realizing it.

Studies have shown that sleep apnea can lead to problems like irritability, daytime fatigue, depression, hypertension, heart attack, and stroke, but recent studies have shown that the risks are actually more serious than, well, a heart attack. And while obesity can lead to this disorder, the disorder itself can lead to obesity.

The authors of a review posted in The Lancet Diabetes & Endocrinology journal wrote, “Metabolic health … is largely dependent on behavioral factors such as dietary habits and physical activity. In the past few years, sleep loss as a disorder characterizing the 24-hour lifestyle of modern societies has increasingly been shown to represent an additional behavioral factor adversely affecting metabolic health.”

...

“Our findings show that sleep apnea is an independent risk factor for incident pneumonia,” theysaid. “Our results also demonstrated an exposure-response relation in patients with more severe sleep apnea may have a higher risk of pneumonia than patients with sleep apnea of milder severity.”

Heart disease, dementia, diabetes … the negative effects continue to mount up. However, along with the worrisome research comes some hope.

Continuous positive airway pressure devices, or CPAP machines, are currently the most common treatment out there. They consist of a plastic facial mask, which the patient wears at night, connected by a flexible tube to a small bedside machine. Using air pressure, it keeps the patient’s airways open during sleep.

“We know that obstructive sleep apnea is a potential cause of high blood pressure, and we know that CPAP use is associated with reductions in blood pressure in people with hypertension,” sayssleep specialist Vishesh K. Kapur, MD. “And now there is reasonable evidence that this treatment can prevent high blood pressure in patients who don’t already have it.”

Modern CPAP machines also come with a built-in humidifier to help prevent dryness in the throat/nasal passages."

...

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No technology helps kids get healthy sleep

This article explains why having no technology in a child's bedroom is pivotal to ensure the child gets healthy and quality sleep.

Here's the scenario: A child is glued to his Xbox, or maybe his iPhone or iPad and won't go to bed. Frustrated, mom or dad gives up the fight and walks away, letting the kid play just a little longer -- even though it's a school night.

But an expert on children's sleep says parents need to buck-up.

Dr. Daniel Lewin, associate director of Pediatric Sleep Medicine at Children's Medical Center, says he too has a child who wants to be on the computer constantly.

"It's simply modeling and limit setting, which is critical," Lewin says.

It comes down to parents limiting their own exposure to electronics, especially while in front of children. This helps show the behavior they'd like their kids to mimic.

Lewin says in a culture with constant access to electronic media, there's a lot of pressure to perform.

But "those kids who are on media devices to do their homework and when that's done right before bedtime they're impacting their sleep," says Lewin.

When it comes to kids, Lewin recommends making sure the electronics are off at least an hour before bedtime. That's because the light actually shuts down the biological process that initiates sleep.

"Sleeping with a dim light in the bedroom is fine. But sleeping with electronics on in the bedroom is really not optimal," Lewin says.

For children who take ADHD medication, Lewin says it's extra important to make sure he or she is getting a good night's sleep.

"Getting enough sleep at night is critical for attention, for regulation of emotion," says Lewin. He says it's really important to be able to recognize the signs of sleep disorder and to recognize the signs of inadequate sleep.

"We have a lot of kids who are on ADHD medications. We could start by optimizing sleep before putting kids on medications. Some certainly need it," Lewin says.

There's also a relationship between sleep deprivation and mood, including suicidal thoughts. Chronic sleep deprivation can lead to high blood pressure, strokes and Type 2 diabetes.

Children around the ages of 12 and 13 should get 9.5 to 10 hours of sleep. Older children and adolescents should get about 9.5 hours of sleep.

And, Lewin adds, "The American Academy of Pediatrics has been very clear: no TVs in the bedroom and no electronics in the bedroom absolutely critical."

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Children who get more sleep weigh less

A study claims that children who sleep more weigh less than their sleepier counterparts. This shows how important getting enough sleep is to children and their health.

Getting a good night's rest is an essential part of our every-day health. It's as simple as that.

The American Psychological Association shows that as many as 40 million Americans suffer from over 70 different sleep disorders, and 60 percent of adults report having sleep problems a few nights a week or more. Not enough sleep can greatly interfere with daily activities, create moodiness and instability in an individual's life and can also be a contributor to weight gain, among other health problems.

A recent study shows that more than ever, sleep is particularly important for children-and this can play a major contribution to losing weight.

"Achieving a good night's sleep during childhood should be explored as an important strategy to enhance prevention and intervention approaches for obesity," said associate professor of public health at Temple University's Center for Obesity Research and Education in Philadelphia, Chantelle Hart. She is also the lead study author of the research.

While looking at a three-week study involving 37 children ages 8 to 11, findings suggest that increasing sleep could help decrease food intake over time and improve weight regulation in this age group.

The children who added sleep tended to eat less, with an average of 134 calories a day. They also shed about half a pound on average and had lower morning levels of the hormone leptin-a 16-kDa adipokin that plays a key role in weight regulation.

Researchers are hoping to determine if sleep over a longer period may help prevent weight loss, as well.

"The evidence is incredibly strong and consistent that a short list of lifestyle factors has a phenomenal influence on weight, health and even gene expression," Dr. David Katz, director of the Yale University Prevention Research Center in New Haven, Conn. said, via Health.

Combined with a good night's rest, physical activity, eating a healthy diet, not smoking and stress reduction, these all play an important role in helping lose or maintain a healthy weight.

While adults can scrap by with eight hours a night, the National Sleep Foundation suggests that children and teens may need more.

For instance, school-aged children should get 10 to 11 hours a night while teens need around 9.25 hours of sleep, according to the organization.

At the end of their research, study authors note that while there is not a solid link between more sleep and weight loss, it potentially opens the door for greater research regarding the topic.

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Sleep disorders in children may be caused by winter viruses

Sleep disorders in children related to breathing during sleep may be due to winter viruses.

A good night's sleep is important to our children's development. But with the first day of school just passed, many children are at increased risk for sleep breathing disorders that can impair their mental and physical development and hurt their academic performance.

A study conducted in North America in 2011 showed that the frequency of sleep-disordered breathing increases in the winter and spring. Until now, researchers believed asthma, allergies and viral respiratory infections like the flu contributed to disorders that affect children's breathing during sleep.

Now, in a new study conducted at the Pediatric Sleep Center at the Tel Aviv Sourasky Medical Center and published in the journal Sleep Medicine, Riva Tauman and her fellow researchers of the Sackler Faculty of Medicine at Tel Aviv Univ. have shown that asthma and allergies do not contribute to pediatric sleep-disordered breathing. Viruses alone, they say, may be responsible for the seasonal variation seen in children.

The researchers say the study has broad implications for the treatment of sleep-breathing disorders in children, bolstering the idea that the time of year is relevant when treating children for sleep-disordered breathing in borderline cases.

Blowing hot and cold

"We knew from research and clinical practice that sleep-disordered breathing in children gets worse during the colder months," Tauman says. "What we didn't expect is that the trend has nothing to do with asthma or allergies."

"Sleep-disordered breathing" is a blanket term for a group of disorders. One of the common disorders is obstructive sleep apnea, in which the upper airway becomes blocked, usually by enlarged tonsils or adenoids, causing snoring and, in more severe cases, breathing pauses that lead to poor-quality and fragmented sleep and decreased oxygen and elevated carbon dioxide levels in the bloodstream.

In the long term, sleep-disordered breathing in children can cause stunted growth, heart disease and neurocognitive problems associated with diminished school performance, impaired language development and behavioral issues.

In their study, Tauman and her Sackler Faculty of Medicine colleagues Michal Greenfeld and Yakov Sivan statistically analyzed the cases of more than 2,000 children and adolescents who were referred to the sleep center to be tested for suspected sleep-disordered breathing between 2008 and 2010. Confirming earlier results of a 2011 study of five- to nine-year-olds, the researchers found that pediatric sleep-disordered breathing is worse in the winter — which in Israel they defined as from November to March — than in the summer. The seasonal variability is most apparent in children less than five years old, they found.

The researchers also found that wheezing and asthma do not contribute to the trend.

Based on their findings, the researchers speculate that viral respiratory infections — which are more prevalent in younger children and during colder months — are the major contributor to the seasonal variability seen in pediatric sleep-disordered breathing.

Taking the long view

If the sleep clinic tests had all been conducted in the winter, the researchers estimate that seven percent more children would have been diagnosed with sleep-disordered breathing. Seven percent fewer would have been diagnosed if all the tests had been done in the summer, they estimate.

"Our study suggests that if a child comes into the sleep laboratory in the winter with a mild case, I may consider not treating him. I can assume he will be better in the summer," says Tauman. "But if he has only mild symptoms in the summer, I can assume they are more severe in the winter."

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Sleep and academic success in children

This article discusses how important sleep is to academic success for young children.

CHILDREN who have trouble sleeping tend to do worse in school than their peers who get a good night’s sleep, a new study suggests.

Researchers in Brazil looked at children aged seven to 10 who attended São Paulo public schools. They found children with symptoms of sleep disorders or sleep breathing disorders earned lower grades than those without problems sleeping, on average.

Thirteen percent of children with difficulty sleeping had failing grades in Portuguese, compared with 9% of those without sleep problems. Likewise, 25% of children with disrupted sleep had failing maths grades, versus 8% of children without trouble sleeping.

"Because (symptoms of sleep disorders) and particularly (sleep breathing disorders) are highly prevalent, we suggest that all health professionals and educators become aware of this striking effect and take appropriate actions to solve or mitigate what could very well constitute a public health issue," researchers led by Dr Luciane Bizari Coin de Carvalho from the Universidade Federal de São Paulo write.

In the US, experts estimate that roughly a quarter of children have disrupted sleep at some point during childhood. There are no definitive statistics on how many South African children have disrupted sleep patterns, but experts say rates are likely to be as high, if not slightly higher in this country, for a variety of socioeconomic reasons.

Erratic bedtime hours and anxiety, either at school or at home, may contribute.

Sleep disorders

Other children may have unrecognised sleep disorders, such as sleep walking, nightmares or insomnia, or sleep breathing disorders such as sleep apnea. Some medications, including those for asthma or attention-deficit/hyperactivity disorder, can affect sleep. The underlying medical problems may also cause sleep disturbances.

Poor sleep among children has been tied to obesity, which over the long term increases the risk of heart disease and diabetes. And poor school performance has been linked to early dropout rates, so the new findings may have implications beyond getting a good night’s sleep, researchers say.

From 1999 to 2001, the researchers distributed 5,400 questionnaires asking about symptoms of sleep disorders and sleep breathing disorders to children in São Paulo public schools.

Then they looked at the Portuguese and maths grades of 2,384 children whose parents filled out and returned the questionnaire.

The study team found about 31% of the children had symptoms of sleep disorders — such as difficulty falling or staying asleep, or feeling sleepy all the time — and close to 27% had sleep breathing disorders. Those students’ grades were significantly lower than the grades of children without sleep disorder symptoms.

In Brazil, grades are based on a scale of 0 to 10, with 5 considered passing. Average Portuguese grades were 6.6 for children with sleep problems, compared with 7.1 among those with no sleeping trouble.

Likewise, children with symptoms of sleep disorders or sleep breathing disorders earned an average grade of 6.3 in maths, compared with 7.1 for other children, according to findings published in the journal Sleep Medicine.

Dr Carl Bazil, a neurologist and director of the division of epilepsy and sleep at New York-Presbyterian/Columbia University Medical Centre in New York City, notes that this study fills a research void.

Learning information

"There’s growing information, mainly in adults, that you need good quality sleep to process and learn new information," Dr Bazil says.

"It stands to reason that, if anything, sleep would be more important in children, but there’s very little information in children about sleep disturbance and learning."

Research has shown that sleep deprivation might affect certain parts of the brain, especially the frontal lobes. The frontal lobes control executive function, which is the ability to make decisions, form memories, plan for the future and inhibit socially undesirable behaviour, such as fighting with a classmate.

However, the new study cannot say definitively that sleep problems were to blame for poor grades, researchers say.

"This study doesn’t prove that a sleep disturbance causes decreased academic performance," Dr Bazil says, "but it shows an association. Basically every category of sleep disturbance the authors looked at correlated with decreased academic performance."

The researchers relied on parents’ reports of their children’s sleep, rather than bringing children into a sleep lab overnight, for example.

The study is "far from perfect", Dr Bazil says. But, "it’s a first step in emphasising that sleep in children is something that’s important, not only to prevent them from being sleepy but to make sure that they learn.

"I think this study will help raise awareness that sleep is particularly important in children."

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Ways to get children to sleep more

This article discusses why children may not be sleeping much and how to get them to sleep more.

Asking sleep experts for advice on how to put children to bed often feels like an exercise in futility. The standard tips are banal and predictable: avoid caffeine; remove the TV from their bedroom; don’t sleep on a full stomach; put up dark blinds. You have the feeling the experts are holding out on us—there has to be something more. And there is. Here’s the stuff they’d love to tell you, if they weren’t afraid of overwhelming you with science.

• Ever wonder why most people sleep better when their bedrooms are cool? It’s because the circadian rhythm system that helps regulate sleep cycles is not just light sensitive, it’s temperature sensitive. Anything above a neutral air temperature both slows the body’s initiation of sleep and changes sleep patterns—a hotter room means an increase in non-REM sleep.

• 77 percent of children use television as part of their pre-bedtime routine. Sitting still and vegging out for half an hour should, theoretically, help a child unwind, as long as they’re not watching a show that excites them too much. However, the brightness of the screen undermines the theory. The light from a television or computer can delay both the necessary drop in core body temperature and melatonin production—and thus delaying sleep onset—by two hours.

• We’re all familiar with the agony of being super exhausted, yet not being able to fall asleep for hours. What gives? It’s because after just a few days of shortened sleep, the brain starts making extra stress hormone cortisol. It takes six times as long for this stress hormone to drop to a low-enough level that sleep is possible.

• In one study of 170 children, those in white-collar families tended to be in bed later and get up earlier than those in working-class families. Yet they actually got more actual sleep. How is that possible? It’s because their bedtimes and wake-times were more consistent; they stuck to their routine. This made their sleep more efficient—they rolled around in bed far less.

• Inconsistent bedtimes are, for all practical purposes, homemade jet lag—the desynchronization of the two systems that regulate sleep, the circadian rhythm and the homeostatic pressure system. Staying up three hours later on weekends is equivalent to flying across three time zones every weekend.

• With children averaging three hours of television per day, it’s hard to make the case children are universally overscheduled. But the most driven children are the most overscheduled—and the most sleep deprived. In some ways, these busy overachievers are those who concern the experts the most. According to University of Minnesota’s Dr. Kyla Wahlstrom, a motivated student can sacrifice sleep to maintain high GPAs, but she may pay for that success with higher levels of depression and stress. Teen boys who have a high number of extracurriculars are significantly more likely to be involved in a fall-asleep car crash. And those with part-time jobs both sleep less and have lower grades.

• For the majority of kids, rather than thinking it’s a choice between sleep and activities, the opposite is true: Students who sleep more are involved in more afterschool activities—with no detriment to their grades. They have the energy to be involved. Schools that have delayed start times have seen their students sleep more and increase their participation in sports and extracurriculars.

• Naps are not quite the salve we imagine. They appease the homeostatic pressure system, but not the circadian. You wake up feeling better—a two-hour nap is equivalent to 150 mg of caffeine—but naps do nothing to repair diminished cognitive functioning. The intellect is just as dulled after the nap as before. Kindergartners who take long naps, for instance, do worse on puzzle-solving.

• 16 percent of kids snore a few times a week. As recently as 2002, the American Academy of Pediatrics opined that children’s snoring was a benign condition not warranting treatment. Just five years later, researchers now caution that kids’ snoring is not like adult snoring at all—even a little snoring is a major cause for concern, because their developing brains can be deprived of oxygen.

• Common sleep disorders such as nightmares, restless leg syndrome, and frequent night waking can have a startlingly negative impact on children’s development—from using drugs at 14 to having clinical-level anxiety as adults. Research by University of Michigan’s Dr. Ronald Chervin indicates as many as 25 percent of kids diagnosed with ADHD have an underlying sleep disorder causing their symptoms. If treated for their sleep disorder, the ADHD would magically disappear. Despite the risks posed by sleep disturbance, the number of children treated for them is “vanishingly small.” Parents should consult a qualified sleep specialist—few pediatricians have expertise with sleep problems. Waiting to see if a child grows out of a sleep problem isn’t the answer.

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